I Am Courageous Submission
Please complete this form to send an IAC Bag to a child.
Must be 16 years or younger / Currently fighting a disease or injury / Living in the USA.
Child's Age *
Child's Name *
Your answer
Life Threatening Disease or Injury *
Share your story.
Your answer
Child's Facebook Page or Website
Your answer
Parent/Guardian's First and Last Name *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
E-Mail *
Your answer
Phone
Your answer
I (Parent/Guaradian) agree to allow my child's first name and story to be used to promote "I Am Courageous" events, encourage others and help continue this ministry. *
Please initial to agree to the above terms.
Your answer
Submit
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This form was created inside of Justin Graves Band.